Screening for Eosinophilic Esophagitis in the Pediatric Asthma Clinic Leads to Increased Diagnosis and Identifies a High Prevalence of Disease.

Abstract

Eosinophilic esophagitis (EoE) is a chronic, progressive disease associated with atopic conditions, including asthma. EoE prevalence among pediatric asthma patients remains poorly characterized. Delayed EoE diagnosis is common and contributes to complications including stricture formation and growth failure. Estimate the prevalence of EoE among pediatric asthma patients using noninvasive screening. A modified Pediatric Eosinophilic Esophagitis Symptom Severity v2.0 (PEESSv2.0) survey was administered to patients (age, 7-17 years) with asthma or parents (patients' age, 3-6 years) in a tertiary care center's asthma and allergy clinic. The presence of symptoms deemed concerning for EoE by the allergist prompted referral to gastroenterology. Data were collected through completion of gastrointestinal workup including endoscopy when indicated. Of 189 participants, 152 (80.4%) screened positive, 72 (47.4%) of whom were referred to gastroenterology. Forty-four (61.1%) completed the referral. Among the 24 who underwent endoscopy, 8 (33%) were diagnosed with EoE. The total projected prevalence of EoE among patients with asthma in the asthma and allergy clinic population is 8.0% (95% CI, 5.1%-11.7%); prevalence rises to 13.9% (95% CI, 10.1%-18.4%) when accounting for nonparticipants and those lost to follow-up. Vomiting was the only individual screening symptom significantly associated with EoE diagnosis (P = .001). Demographic characteristics of patients with EoE mirrored the study cohort, with 75% identifying as non-White. Screening in a pediatric asthma clinic identified a previously unrecognized high prevalence of EoE. This approach may facilitate earlier diagnosis, prevent fibrostenotic complications, and reduce racial disparities. Further studies are needed to refine screening tools and evaluate applicability across atopic populations.